From Tehran to Dallas

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• From Tehran to Dallas
• Jafar Forghani, MD
• Internist-Rheumatologist
• Iran University of Medical Sciences (IUMS)
• Tehran, Iran
• March 17, 2006

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Jafar Forghani,MD

• Born in Abadan, Iran
  1945
• MD degree from Isfahan Medical school
  1963-1970
• Internship _at_ Malden Hosp.,Malden, MA
  1973-1974
• Medical residencies
• Rheumatology fellowship
• _at_ Cleveland Clinic, Cleveland, OH
  1974-1978
• Prof. of medicine , Dep. Internal Med
• Head, division of Rehumatology
  
• _at_
  IUMS 1978- present
• Member Iranian Board of Internal Medicine
• Iranian Board of
  Rheumatology
• Iranian Rheumatology
  Association

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From Tehran to Dallas

• Iran Tehran
• Medical schools in Iran
• Internal medicine rheumatology in Iran
• Iran University of Medical Sciences (Tehran)
• Examples of patients and quizzes for medical
  residents
• Sabbatical study in Dallas

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Iran-Persia

• Iran (Eran, Arynam, land of Aryans)

The Aryans came about 2000 BC and split into
two main groups, the Medes and the Persians.
The Persian Empire founded (c.550 BC) by Cyrus
the Great. It was succeeded, after a period of
Greek and Parthian rule, by the Sassanid in the
early 3d century (AD).
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Achaemenid Empire(500 B.C.)
The Achaemenid Persians of central Iran ruled an
empire which comprised Iran, Mesopotamia, Syria,
Egypt, and parts of Asia Minor and India from
the 6th to the 4th century B.C.
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The Achaemenids ceremonial capital was
Persepolis in southern Iran founded by King
Darius the Great (522-486 B.C.)
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XPa Trilingual 1 Gate of Xerxes North Door Jamb,
West Doorway Elamite Inscription Old Persian
Inscription Akkadian Inscription
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Cyrus II Cyrus(Koresh) the great
Length 22.86 cm
Cyrus Cylinder
This cylinder has sometimes been described as the
'first charter of human rights'
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Text of the declaration(Cyrus Cylinder) I am
Cyrus, King of Persia, great king, mighty king,
King of Babylon, king of the land of Sumer and
Akad, King of ......, king of the four quarters
of Earth, son of Cambysis (Kambujiye), great
king, king of Anshan, grandson of Cyrus (Kurosh),
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Text of the declaration(Cyrus Cylinder)
As to the inhabitants of Babylon who against the
will of the gods were enslaved, I abolished the
corvee which was against their social standing,
I freed all slaves. I brought relief to their
dilapidated housing, putting thus an end to
their misfortunes and slavery
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Now that I put the crown of kingdom of Iran,
Babylon, and the nations of the four directions
on the head with the help of (Ahura) Mazda, I
announce that I will respect the traditions,
customs and religions of the nations of my
empire and never let any of my governors and
subordinates look down on or insult them until I
am alive.
I never let anyone oppress any others, and if
it occurs , I will take his or her right back and
penalize the oppressor. And until I am the
monarch, I will never let anyone take possession
of movable and landed properties of the others by
force or without compensation. Until I am alive,
I prevent unpaid, forced labor.
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Text of the declaration(Cyrus Cylinder)
To day, I announce that everyone is free to
choose a religion. People are free to live in all
regions and take up a job provided that they
never violate other's rights.
No one could be penalized for his or her
relatives faults. I prevent slavery and my
governors and subordinates are obliged to
prohibit exchanging men and women as slaves
within their own ruling domains. Such a
traditions should be exterminated the world over
......
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Persepolis was burned by Alexander the great in
331 B.C. Only the columns, stairways, and door
jambs of its great palaces survived the fire.
The stairways, adorned with reliefs representing
the king, his court, and delegates of his empire
bringing gifts, demonstrate the might of the
Persian monarch.
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Perspolis 600 miles south of Tehran
The Achaemenids ceremonial capital was
Persepolis in southern Iran founded by King
Darius the Great (522-486 B.C.)
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IRAN Persepolis - Portico of the
"Hundred-columned Hall" of Darius (ca. 520 B.C.).
The body of a colossal bull from the gateway can
be seen at the lower left.
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U.S.A. Chicago - Colossal bull head from
Persepolis, as restored and installed in the
Iranian Hall of the Oriental Institute Museum
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Area1.648 million sq km Slightly larger than
Alaska Land boundaries total 5,440 km Border
countries Afghanistan 936 km, Armenia 35 km,
Azerbaijan-proper 432 km Azerbaijan-Naxcivan
exclave 179 km, Iraq 1,458 km, Pakistan 909 km,
Turkey 499 km, Turkmenistan 992 km Population
70 million
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Milad Tower Tehran
Azadi Square Tehran
Tehran Population 10 to 12 millions
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Isfahan (Esfahan) half the world
Naghsh-e-Jahan (Shah) square
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Sheikh Lotfollah mosque - Isfahan
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Medical Schools in Iran
Year 1979 Year 2005
Medical Schools 10 gt50
Population of Iran 40,000,000 70,000,000
Physicians 12,000 60,000
Internists (total) (Subspecialists) lt1000 lt100 3000 1000
Rheumatologists lt10 120
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Tehran University 1934
Iran University of Medical Sciences 1974
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Internal Medicine in Iran

• 4 year program gt 3 y. program gt 4 y. program
• Admission through national entrance exams
• Promotion by universities evaluations national
  exam
• Board eligible internists get license to practice
  
• National Board of Internal Medicine
• Board certified internists may go to subspecialty
  programs or employed as medical staff in
  universities
• Currently there are 7 approved subspecialty
  programs Card., Endo., GI., Hem-Onc., Nephro.,
  Pulm., and Rheum. (Infectious disease straight
  from MD)

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Morning Report Internal Medicine Hazrat Rasool
Hospital
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Medical staff Internal Medicine, Hazrat Rasool
Hospital
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Rheumatology
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Rheumatology in Iran

• Fellowship programs started in 1983
• 2 years clinical programs in 5 centers
• ( 3 in Tehran, 1 in Shiraz, and 1 in Mashad)
• Admission through national entrance exams
  (written and oral)- 11 positions each year
• Subspecialty Board of Rheumatology exam after
  completion of 2 years fellowship

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Hazrat Rasool Hospital- Rheumatology staff and
fellows
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Rheumatology fellows waiting for oral exam (Board)
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• Common and uncommon rheumatic diseases in Iran
• Interesting cases
• Quizzes

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A 25 year old female presented with problem with
walking
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Unilateral sacroiliitis(Brucellosis)
Brucella spondylitis
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Behcets Disease
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A 32 year old female with 12 years history of
SLE (malar rash, ANA Anti DNA, GN,arthritis)
was admitted to hospital for treatment of
sever thrombocytopenia.
She had been on prednisolone 5 mg
t.i.d, Chloroquine 150 mg/day and Azathioprine 50
mg b.i.d. for last 3 years. She was treated with
3 pulses of Methylprednisolone 1000 mg/day
followed by daily plasmaphresis via a Jugular
vein catheter for 2 weeks and then 3 time/week
for next 3 weeks. She has had pain of right hip
on walking since 5 years ago. The X-ray of
pelvis on admission is shown.
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X-ray on admission
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She developed fever( up to 104 ) 6 weeks after
admission . Jugular catheter was removed and IV
antibiotics started. One week later, she
complained of severe pain in right hip. She was
not able to stand or walk. Right hip was in
external rotation position and all movements were
painful. The X-ray of pelvis at this time is
shown.
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X-ray 7 weeks after admission
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Interpret X-rays. What is your diagnosis?
X-ray 7 weeks later
X-ray on admission
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30 year old woman with chronic joint pain and
swelling in hands and feet for 10 years.
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A patient with jaundice
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NEJM Vol.336, No 12, March 20,1997 Medical
Mystery
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From an old book
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Sabbatical study

• 3 months _at_ Arthritis Consultation Center ,
• Presbyterian Hospital of Dallas
• To observe design, and process of clinical
  trials on biologic agents for treatment of
  rheumatoid arthritis and other rheumatic
  diseases.
• To observe implementation of medical residency
  curriculum at PHD.

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Painting by Mahmood Farshchian
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Thank you for your attention